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Rotator Cuff Disease Follow-up

  • Author: André Roy, MD, FRCPC; Chief Editor: Stephen Kishner, MD, MHA  more...
Updated: Apr 21, 2016

Further Outpatient Care

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  • A follow-up visit should be scheduled 6-8 weeks following the initial evaluation. During this time period, prescribed tests should have been performed and results received. Effectiveness of the initial treatment should be assessed and, if necessary, modifications made.
  • Following visits depend on the responsiveness to the treatment. Recommend 2 months of follow-up visits until the condition has improved or stabilized.


See the list below:

  • No medication or homeopathic agent is known to prevent tendon degeneration.
  • Avoidance of highly repetitive activities or sustained shoulder posture with greater than 60° of flexion or abduction is probably the best prevention.

Patient Education

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Contributor Information and Disclosures

André Roy, MD, FRCPC Consulting Staff, Department of Physiatry, Montreal University Hospital Center and Montreal Rehabilitation Institute

André Roy, MD, FRCPC is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.


Thierry HM Adahan, MD LMCC, CCFP, FRCPC, FABPMR, Head, Pain Rehabilitation Center, Haim Sheba Medical Center, Tel Hashomer, Israel

Thierry HM Adahan, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Benjamin Dahan University of Montreal, Canada

Disclosure: Nothing to disclose.

Manon Bélair, MS Consulting Staff, Hospital Notre-Dame, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

  1. Codman EA. The shoulder. In: Thomas T, ed. Rupture of the Supraspinatus Tendon and Other lesions in or About the Subacromial Bursa. Boston:. 1934.

  2. Duplay. Rotator Cuff Disease. Arch Gén Méd. 1872. 2:513.

  3. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972 Jan. 54(1):41-50. [Medline].

  4. Neer CS 2nd. Impingement lesions. Clin Orthop. 1983 Mar. (173):70-7.

  5. Von Meyer AW. Chronic functional lesions of the shoulder. Arch Surg. 1937. 35:646-674.

  6. Von Meyer AW. Further observations upon use-destruction in joint. J Bone Joint Surg. 1922. 4:491-511.

  7. Von Meyer AW. Further evidence of attrition in the human body. Am J Anat. 1924. 34:241-260.

  8. Von Meyer AW. The minute anatomy of attrition lesions. J Bone Joint Surg. 1931. 13A:341.

  9. Oliva F, Piccirilli E, Bossa M, et al. I.S.Mu.L.T - Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J. 2015 Oct-Dec. 5 (4):227-63. [Medline]. [Full Text].

  10. Longo UG, Berton A, Papapietro N, Maffulli N, Denaro V. Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci. 2012. 57:1-9. [Medline].

  11. Bigliani LU. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986. 10:228.

  12. Ozaki J, Fujimoto S, Nakagawa Y, et al. Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera. J Bone Joint Surg Am. 1988 Sep. 70(8):1224-30. [Medline].

  13. Walch G, Liotard JP, Boileau P, Noel E. [Postero-superior glenoid impingement. Another shoulder impingement]. Rev Chir Orthop Reparatrice Appar Mot. 1991. 77(8):571-4. [Medline].

  14. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970 Aug. 52(3):540-53. [Medline].

  15. Nixon JE, DiStefano V. Ruptures of the rotator cuff. Orthop Clin North Am. 1975 Apr. 6(2):423-47. [Medline].

  16. Matsen FA 3rd. Practical Evaluation and Management of the Shoulder. Philadelphia:. WB Saunders Co. 1994:1-242.

  17. Matsen FA 3rd. Rotator cuff. In: Rockwood CA Jr, Matsen FA, eds. The Shoulder. 3rd ed. Philadelphia:. WB Saunders Co. 1998:755-839.

  18. Keener JD, Wei AS, Kim HM, et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009 Jun. 91(6):1405-13. [Medline]. [Full Text].

  19. Longo UG, Berton A, Ahrens PM, Maffulli N, Denaro V. Clinical tests for the diagnosis of rotator cuff disease. Sports Med Arthrosc. 2011 Sep. 19(3):266-78. [Medline].

  20. Ackland DC, Pandy MG. Lines of action and stabilizing potential of the shoulder musculature. J Anat. 2009 May 28. [Medline].

  21. Leroux JL, Thomas E, Bonnel F, Blotman F. Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed. 1995 Jun. 62(6):423-8. [Medline].

  22. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991 May. 73(3):389-94. [Medline]. [Full Text].

  23. Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy. 2009 Jun. 25(6):590-6. [Medline].

  24. Yoo JC, Ahn JH, Yang JH, et al. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2009 Jun. 25(6):573-82. [Medline].

  25. Pegreffi F, Paladini P, Campi F, Porcellini G. Conservative management of rotator cuff tear. Sports Med Arthrosc. 2011 Dec. 19(4):348-53. [Medline].

  26. Collin PG, Gain S, Nguyen Huu F, Ladermann A. Is rehabilitation effective in massive rotator cuff tears?. Orthop Traumatol Surg Res. 2015 Jun. 101 (4 Suppl):S203-5. [Medline].

  27. Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999 May 20. 340(20):1533-8. [Medline].

  28. Wilk KE. Shoulder rehabilitation. In: Physical Rehabilitation of the Injured Athlete. Philadelphia:. 1998:478-553.

  29. Graver JL. Pathologie degenerative de la coiffe des rotateurs, place de la physiotherapie. Rev Rhum (suppl pédagogique). 1996. 63(1):74sp-81sp.

  30. Chan K, MacDermid JC, Hoppe DJ, et al. Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis. J Shoulder Elbow Surg. 2014 Aug 12. [Medline].

  31. Chang KV, Hung CY, Han DS, et al. Early Versus Delayed Passive Range of Motion Exercise for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2014 Aug 20. [Medline].

  32. Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox RB 3rd. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016 Apr. 25 (4):521-35. [Medline].

  33. Cacchio A, De Blasis E, Desiati P, et al. Effectiveness of treatment of calcific tendinitis of the shoulder by disodium EDTA. Arthritis Rheum. 2009 Jan 15. 61(1):84-91. [Medline].

  34. Bateman JE. The Shoulder and Neck. 2nd ed. London:. WB Saunders Co. 1927.

  35. DePalma AF. Variational anatomy and degenerative lesions of the shoulder joint. Instr Course Lect. 1949. 6:255-281.

  36. Duchenne GB. Physiologie des mouvements. 1867: Réédition en fac-similé. Philadelphia:. WB Saunders Co. 1959.

  37. Inman V. Observations of the function of the shoulder joint. J Bone Joint Surg Am. 1944. 26:1-30.

  38. Keyes EL. Anatomical observations on senile changes in the shoulder. J Bone Joint Surg. 1935. 17A:953-960.

  39. Keyes EL. Observations on rupture of supraspinatus tendon. Based upon a study of 73 cadavers. Ann Surg. 1933. 97:849-856.

  40. Lindblom K. On pathogenesis of ruptures of the tendon aponeurosis of the shoulder joint. Acta Radiol. 1939. 20:563.

  41. McLaughlin HL. Lesions of the musculotendinous cuff of the shoulder. The exposure and treatment of tears with retraction. J Bone Joint Surg. 1944. 26:31-51.

  42. Pettersson G. Rupture of the tendon aponeurosis of the shoulder joint in antero-inferior dislocation. Acta Chir Scand. 1942. 77:1-187.

  43. Smith JG. Pathological appearances of seven cases of injury of the shoulder joint with remarks. London Med Gazette. 1834. 14:280.

  44. Teefey SA, Hasan SA, Middleton WD, et al. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000 Apr. 82(4):498-504. [Medline].

  45. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am. 1981 Oct. 63(8):1208-17. [Medline].

  46. Uhthoff HK. The effect of aging on the soft tissues of the shoulder. In: Matsen FA, Fu FH, Hawkins RJ, eds. The Shoulder: A Balance of Mobility and Stability. Rosemont, Ill:. American Academy of Orthopaedic Surgeons. 1993:269-278.

  47. Valadie AL 3rd, Jobe CM, Pink MM, et al. Anatomy of provocative tests for impingement syndrome of the shoulder. J Shoulder Elbow Surg. 2000 Jan-Feb. 9(1):36-46. [Medline].

  48. van der Heijden GJ, van der Windt DA, de Winter AF. Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials. BMJ. 1997 Jul 5. 315(7099):25-30. [Medline].

  49. Williams HJ, Ward JR, Egger MJ, et al. Comparison of naproxen and acetaminophen in a two-year study of treatment of osteoarthritis of the knee. Arthritis Rheum. 1993 Sep. 36(9):1196-206. [Medline].

  50. Wilson CL. Pathologic study of degeneration and rupture of the supraspinatus tendon. Arch Surg. 1943. 47:121-135.

  51. Winters JC, Sobel JS, Groenier KH, et al. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study. BMJ. 1997 May 3. 314(7090):1320-5. [Medline].

  52. Wuelker N, Plitz W, Roetman B. Biomechanical data concerning the shoulder impingement syndrome. Clin Orthop. 1994 Jun. (303):242-9. [Medline].

Normal plain radiograph of the shoulder in internal, external, and neutral positions.
Subchondral sclerosis of the humeral head as seen in chronic tendinopathy.
Calcification at the insertion of the rotator cuff, another sign of chronic tendinopathy.
Presence of a bony spur on the inferior surface of the acromion.
Superior migration of the humeral head in chronic, complete rotator cuff tear. Note the reduced space between the acromion and the humeral head.
Normal double-contrast arthrography of the shoulder.
This image depicts the channel between the articular capsule and the subacromial-subdeltoid bursa in a complete rotator cuff tear.
Even if the channel cannot be always identified, the presence of contrast medium in the subdeltoid-subacromial bursa signs the presence of a complete rotator cuff tear.
Complete rotator cuff tear with presence of contrast medium in the subacromial-subdeltoid bursa. Also note the multiple irregularities in the synovial fluid showed as multiples filling defects.
Computed tomography (CT)-arthrography scan of the shoulder in the axial plane. Note the presence of air and contrast in the subacromial-subdeltoid bursa.
Full-thickness tear of the supraspinatus seen as a hyperintensity line through the full thickness of the tendon (as viewed in a flash 2-dimensional magnetic resonance imaging [MRI] sequence in the coronal oblique plane).
Slight hyperintensity signal within the tendon without transsectional hyperintensity throughout the tendon is compatible with tendinopathy without complete tear. Additionally, note the presence of the hyperintensity signal in the region of the subdeltoid-subacromial bursa, which indicates bursitis.
Calcifications are seen as hypointense foci in flash 2-dimensional.
Arthro–magnetic resonance imaging (MRI) can help to identify labral tears, as seen in this image. The contrast medium penetrates between the labrum and the articular surface.
Ultrasonography is another modality that can demonstrate a complete rotator cuff tear. This image reveals a gap of more than 2 cm between both extremities of the torn tendon.
Table 1: Radiological Findings on Plain Film
 TendinitisPartial TearComplete Tear
Soft tissue calcification(s)XXX
Greater tuberosity flattening or hypertrophyXXX
Humeral head cystsXXX
Acromial sclerosisXXX
Acromial spursXXX
Acromion type 2 and 3XXX
Acromioclavicular osteoarthritisXXX
Upward migration of humeral head ( < 6 mm)  X
Table 2: Radiological Findings on MRI
TendonsSoft tissuesBone structures
Thickening of rotator cuff tendon (RCT)Intra-articular effusionGreater tuberosity flattening or hypertrophy
Grey signal intensity within the RCTSubacromial-subdeltoid bursal effusionHumeral head cysts
Fluid-filled gap across the tendonMuscle atrophyAcromial sclerosis
RetractionThickening of coracoacromial ligamentAnterior acromial spur
Grey signal intensity in the long head of biceps tendon Acromion type 2 and 3

Acromioclavicular osteoarthritis

Rupture of the long head of the biceps tendon Upward migration of humeral head

Os acromiale

Calcifications in the supraspinatus, infraspinatus or teres minor Bone edema
Table 3: Radiological Signs of Specific Disorders
 TendinitisPartial TearComplete Tear
Thickening of RCTXX 
Grey signal intensity within the RCTXX 
High signal intensity crossing only 1 surface of the tendon X 
Fluid-filled gap across the tendon  X
Retraction  X
Grey signal intensity in the long head of the biceps tendonXXX
Rupture of the long head of the biceps tendonXXX
Calcifications in the supraspinatus, infraspinatus or teres minor tendonXXX
Intra-articular effusionXXX
Subacromial-subdeltoid bursa effusion   
Muscular atrophy  X
Thickening of coracoacromial ligamentXXX
Greater tuberosity flattening or hyper-trophyXXX
Humeral head cystsXXX
Acromial sclerosisXXX
Anterior acromial spurXXX
Acromion type 2 and 3 XX
Acromio-clavicular osteoarthritisXXX
Upward migration of humeral head  X
Table 4: Ultrasonographic Signs of Rotator Cuff Disease
Primary signsAccessory findings
Focal interruption of tendonRetraction of the muscle
Presence of fluid in the gapSynovial cysts in the humeral head
Lost of convexity of the tendon and bursaHyperechoic foci + shadowing (calcium)
Uncovered cartilage signFluid effusion in the bursa
Diffusely hypoechoic tendon articulationFluid effusion in the Ganglion cysts
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